Clinical Edits

The Texas Managed Medicaid STAR/CHIP formulary, including the Preferred Drug List and any clinical edits, is defined by the Texas Vendor Drug Program.

Texas Vendor Drug Program Clinical Edit Website: https://www.txvendordrug.com/formulary/clinical-prior-authorizations-managed-care

Please click on the link(s) below to view the Texas Medicaid STAR and CHIP implemented clinical edits.

Click here for Prior Authorization information.

Type	Name		File Size
PDF File	Accolate Eff. Date: 02/07/2023	ACCOLATE, ZAFIRLUKAST	224 KB
PDF File	ADD_ADHD Eff. Date: 10/27/2023	ADDERALL, AMPHETAMINE, AMPHETAMINE ER, AMPHETAMINE/DEXTROAMPHET SALTS, AZSTARYS, ADZENYS, ADZENYS-ODT, AMPHETAMINE/DEXTROAMPHET SALTS ER, ADHASIA XR, APTENSIO XR, CLONIDINE, CONCERTA ER, COTEMPLA, DAYTRANA, DESOXYN, DEXMETHYLPHENIDATE, DEXEDRINE, DEXMETHYLPHENIDATE, DYANAVEL, EVEKEO, FOCALIN XR, FOCALIN, GUANFACINE, INTUNIV, JORNAY, METHAMPHETAMINE, METHYLIN, METHYLPHENIDATE, METHYLPHENIDATE ER, METHYLPHENIDATE CD, MYDAYIS, PROCENTRA, QELBREE, QUILLICHEW, QUILLIVANT, RITALIN, STRATTERA, VYVANSE, ZENZEDI	847 KB
PDF File	Agents for Gaucher’s Disease - HHSC Eff. Date: 12/01/2022	CERDELGA, CEREZYME, ELELYSO, MIGLUSTAT, VPRIV, ZAVESCA	833 KB
PDF File	Aliskiren - HHSC Eff. Date: 07/05/2022	ALISKIREN, TEKTURNA	2 MB
PDF File	Allergen Extracts - HHSC Eff. Date: 09/20/2023	GRASTEK, ORALAIR, PALFORZIA, RAGWITEK	1 MB
PDF File	Amantadine Extended-Release Agents - HHSC Eff. Date: 10/18/2022	GOCOVRI ER, OSMOLEX ER	610 KB
PDF File	Androgenic Agents - HHSC Eff. Date: 12/20/2022	ANDRODERM, ANDROGEL 1%, ANDROGEL 1.62%, FORTESTA, JATENZO, KYZATREX, NATESTO NASAL, TESTIM, TESTOSTERONE, TLANDO, VOGELXO	741 KB
PDF File	Antiemetics - HHSC Eff. Date: 07/05/2022	AKYNZEO, APREPITANT, EMEND, GRANISETRON HCL, SANCUSO	717 KB
PDF File	Antipsychotics Eff. Date: 12/01/2023	ABILIFY, ABILIFY ASIMTUFII, ABILIFY DISCMELT, ABILIFY MAINTENA, ABILIFY MYCITE, AMITRIPTYLINE/PERPHENAZINE, ASENAPINE, ARIPIPRAZOLE, ARISTADA ER, CAPLYTA, CHLORPROMAZINE, CLOZAPINE, CLOZAPINE ODT, CLOZARIL, FANAPT, FAZACLO, FLUPHENAZINE, GEODON, HALDOL DECANOATE, HALOPERIDOL, INVEGA ER, INVEGA HAFYERA, INVEGA SUSTENNA, INVEGA TRINZA, LATUDA, LOXAPINE, LYBALVI, MOLINDONE HCL, OLANZAPINE, OLANZAPINE ODT, OLANZAPINE/FLUOXETINE, ORAP, PALIPERIDONE ER, PERPHENAZINE, PERSERIS ER, PIMOZIDE, QUETIAPINE , REXULTI, RISPERDAL , RISPERDAL CONSTA, RISPERDAL M-TAB, RISPERIDONE, SAPHRIS, SECUADO, SEROQUEL, SYMBYAX, THIORIDAZINE, THIOTHIXENE, TRIFLUOPERAZINE, UZEDY ER, VERSACLOZ, VRAYLAR, ZIPRASIDONE, ZYPREXA, ZYPREXA RELPREVV, ZYPREXA ZYDIS	375 KB
PDF File	Antiseizure Agents (Diacomit, Epidiolex & Fintela) Eff. Date: 02/08/2023	EPIDIOLEX, FINTEPLA, DIACOMIT	834 KB
PDF File	Anxiolytics and Sedatives Hypnotics (ASHs) - HHSC Eff. Date: 10/12/2023	ALPRAZOLAM, XANAX, CHLORDIAZEPOXIDE, MEPROBAMATE, OXAZEPAM, DIAZEPAM, CLONAZEPAM, KLONOPIN, CLORAZEPATE, TRANXENE T, LORAZEPAM, TEMAZEPAM, TRIAZOLAM, ZOLPIDEM, ESTAZOLAM, RESTORIL, TEMAZEPAM, ESZOPICLONE, LUNESTA, SONATA, ZALEPLON, INTERMEZZO, ZOLPIDEM, AMBIEN, EDLUAR, BELSOMRA, BUTISOL SODIUM, FLURAZEPAM, HETLIOZ, ROZEREM, DAYVIGO	3 MB
PDF File	Arikayce HHSC Eff. Date: 07/05/2022	ARIKAYCE	628 KB
PDF File	Buprenorphine Agents – HHSC Eff. Date: 02/28/2023	BUNAVAIL, BUPRENORPHINE, BUPRENORPHINE-NALOXON, SUBOXONE, ZUBSOLV	1 MB
PDF File	Carisoprodol - HHSC Eff. Date: 10/20/2022	CARISOPRODOL-ASPIRIN, CARISOPRODOL COMPOUND, CARISOPRODOL CPD-CODEINE, CARISOPRODOL, SOMA	654 KB
PDF File	CGRP Antagonists Acute Eff. Date 12/01/2023	NURTEC, UBRELVY, ZAVZPRET	478 KB
PDF File	CGRP Antagonists, Prophylaxis HHSC Eff. Date 05/18/2023	AIMOVIG, AJOVY, EMGALITY, NURTEC, QULIPTA	783 KB
PDF File	CNS Stimulants - HHSC Eff. Date: 02/01/2023	ARMODAFINIL, MODAFINIL, NUVIGIL, PROVIGIL, SUNOSI, WAKIX	1 MB
PDF File	Contraceptives - CHIP ONLY Eff. Date: 10/22/2012		22 KB
PDF File	Cough/Cold Medications - HHSC Eff. Date: 02/28/2023	ALA-HIST, ALLFEN DM TAB, AP-HIST DM LIQ, APRODINE TAB, BENZONATATE, BROMFED DM CGH SYR, BROMPHENIR-PSEUDO-DM SYR, BROTAPP, CHEST CONG RELIEF, CHLD DELSYM, CHLD COLD & CGH DM ELIXI, CHLD MUCINEX, CHLD DAYCLEAR ALL CGH, CHLO TUSS LIQ, CGH DM, CGH SYR, DALLERGY, DECONEX DMX TAB, DECONEX IR TAB, DELSYM, DEXTROMETHORPHAN ER, DIMAPHEN, ED A-HIST, ED BRON GP LIQ, ED CHLORPED D PEDIATRIC DROPS, ENDACOF-DM LIQ, EX ACTION CGH SYR, GUAIFEN, GUAIFEN ER, GUAIFEN/PSE, HISTEX, IOPHEN, KIDKARE CGH & COLD LIQ, KID'S MUCINEX MINI-MELTS PACK, LODRANE D CAPSULE, LOHIST, LORTUSS, MAXIPHEN, M-END DMX LIQ, M-HIST DM LIQ, MUCINEX, MUCUS RELIEF, NASAL DECON SPRAY, NASOPEN PE LIQ, NIGHT CGH LIQ, NINJACOF LIQ, NOHIST, NOSE DROPS, ORGAN-I, PED CGH-COLD LIQ, PHENYLEPHRINE-PYRILAMINE, POLY HIST, POLY-VENT, POLYTUSSIN, PROMETHAZINE, Q-TUSS, RESCON, RESPAIRE-30, ROBAFEN, RU-HIST D, RYMED, SILTUSS, SINUS RELIEF 1% NASAL SPRAY, SM NASAL SPRAY, SM TUSS DM, STAHIST AD, SUDOGEST SINUS & ALLERGY, TUSS, VANACOF, VANATAB	1 MB
PDF File	Cystic Fibrosis Agents - HHSC Eff. Date: 09/13/2023	KALYDECO, ORKAMBI, SYMDEKO, TRIKAFTA	2 MB
PDF File	Cytokine and CAM Antagonists Eff. Date: 12/01/2023	ACTEMRA, AMJEVITA, ARCALYST, CIBINQO, CIMZIA, COSENTYX, ENBREL, ENSPRYNG, HUMIRA, ILARIS, ILUMYA, KEVZARA, KINERET, LITFULO, OLUMIANT, ORENCIA, OTEZLA, RINVOQ, SILIQ, SIMPONI, SKYRIZI, SOTYKTU, STELARA, TALTZ, TREMFYA, XELJANZ	2 MB
PDF File	Daybue - HHSC Eff. Date: 07/21/2023	DAYBUE	783 KB
PDF File	Desmopressin Eff. Date: 04/07/2023	DDAVP, DESMOPRESSIN ACETATE	358 KB
PDF File	Dextromethorphan Overutilization - HHSC Eff. Date: 10/06/2023	ALA-HIST DM LIQ, AP-HIST DM LIQ, ALLFEN DM TAB, BROMFED DM CGH, BROMPHENIR-PSEUDO-DM SYR, BROTAPP DM LIQ, CHILD DELSYM, CHILD C&C DM ELIX, CHILD MUCINEX, DECONEX DMX TAB, DELSYM 30MG/5ML SUSP, DELSYM CGH+CHEST CNGST DM LQ, DEXTROMETHORPHAN ER 30MG/5ML, DIMAPHEN DM ELIX, ED-A-HIST DM LIQ, ED-A-HIST DM TAB, ENDACOF-DM LIQ, EXT ACTION CGH SYR, GUIAFEN-DM ER 1,200-60MG TAB, HISTEX-DM SYR, IOPHEN DM-NR LIQ, KIDKARE C&C LIQ, LOHIST-DM SYR, LORTUSS DM LIQ, M-END DMX LIQ, M-HIST DM, MAXIPHEN DM TAB, MUCINEX CGH MINI-MELT PACK, MUCINEX DM ER 600-30MG TAB, MUCINEX DM ER 1,200-60MG TAB, MUCINEX FAST-MAX CONG-CGH, MUCINEX FAST-MAX DM MAX LIQ, NOHIST-DM LIQ, PED C&C LIQ, POLY-HIST DM LIQ, POLY-VENT DM TAB, POLYTUSSUN DM, PROMETH-DM SYR, Q-TUSS DM SYR, RESCON-DM LIQ, ROBAFEN CF LIQ, ROBAFEN-DM, ROBAFEN CGH 15MG LIQGEL, ROBAFEN DM CGH-CHEST CONG SYR, RYNEX DM LIQ, SILTUSS DM CGH SYR, SILTUSS DM DAS LIQ, SM TUSS DM, TUSS DM, VANACOF DM LIQ, VANACOF DMX, VANATAB DM CAP, VIRDEC DM DRP	432 KB
PDF File	Diclofenac - HHSC Eff. Date: 10/20/2022	DICLOFENAC GEL 3%, DICLOFENAC SOL 1.5%, PENNSAID SOL 2%	922 KB
PDF File	Dopamine Agonists - HHSC Eff. Date: 10/18/2022	APOKYN, KYNMOBI	597 KB
PDF File	Doxylamine/Pyridoxine - HHSC Eff. Date: 10/29/2019	BONJESTA ER, DICLEGIS DR	254 KB
PDF File	DPP4 Inhibitors - HHSC Eff. Date: 03/27/2019	ALOGLIPTIN, ALOGLIPTIN-METFORMIN, ALOGLIPTIN-PIOGLIT, GLYXAMBI, JANUMET, JANUMET XR, JANUVIA , JENTADUETO, JENTADUETO XR , KAZANO, KOMBIGLYZE XR , NESINA, ONGLYZA , OSENI , QTERN , STEGLUJAN, TRADJENTA	314 KB
PDF File	Emflaza - HHSC Eff. Date: 10/07/2021	EMFLAZA	753 KB
PDF File	Enzymes - HHSC Eff. Date: 10/18/2022	ALDURAZYME, CEPROTIN, ELAPRASE, FABRAZYME, GALAFOLD, NAGLAZYME, NITYR, ORFADIN, REVCOVI, STRENSIQ, VIMIZIM	1 MB
PDF File	Erythropoiesis-Stimulating Agents - HHSC Eff. Date: 04/28/2023	ARANESP, EPOGEN, MIRCERA, PROCRIT, REBLOZYL, RETACRIT	1 MB
PDF File	Evrysdi - HHSC Eff. DAte: 06/09/2022	EVRYSDI	793 KB
PDF File	Fentanyl Agents - HHSC Eff. Date: 03/21/2023	ACTIQ, FENTANYL, FENTORA	3 MB
PDF File	Filspari - HHSC Eff. Date: 10/13/2023	FILSPARI	941 KB
PDF File	FMT Agents - HHSC Eff. Date: 07/26/2023	VOWST	723 KB
PDF File	Gattex - HHSC Eff. Date: 04/28/2023	GATTEX	632 KB
PDF File	GI Motility Agents - HHSC Eff. Date: 10/10/2023	AMITIZA, IBSRELA, LINZESS, ALOSETRON HCL, LOTRONEX, MOVANTIK, MOTEGRITY, RELISTOR, SYMPROIC, TRULANCE, VIBERZI	2 MB
PDF File	GLP1 Receptor Agonist HHSC Eff. Date: 08/09/2023	BYDUREON, BYETTA, MOUNJARO, OZEMPIC, RYBELSUS, SOLIQUA, TRULICITY, VICTOZA, XULTOPHY	794 KB
PDF File	GnRH Receptor Antagonists - HHSC Eff. Date: 09/12/2022	MYFEMBREE, ORIAHNN	922 KB
PDF File	Growth Hormone - HHSC Eff. Date: 07/21/2023	GENOTROPIN, HUMATROPE, NORDITROPIN NORDIFLEX, NORDITROPIN FLEXPRO, NUTROPIN AQ, OMNITROPE, SAIZEN, SEROSTIM, SKYTROFA, SOGROYA, ZORBTIVE	2 MB
PDF File	Hereditary Angioedema (HAE) - HHSC Eff. Date: 03/23/2023	BERINERT, CINRYZE, FIRAZYR, HAEGARDA, KALBITOR, RUCONEST, TAKHZYRO	705 KB
PDF File	HP Acthar - HHSC Eff. Date: 12/02/2022	HP ACTHAR GEL	769 KB
PDF File	Hyperlipidemia Agents (PCSK9 Inhibitors) - HHSC Eff. Date: 10/07/2021	JUXTAPID, PRALUENT, REPATHA	1 MB
PDF File	Ileal Bile Acid Transporter (IBAT) Inhibitors HHSC Eff. Date: 03/30/2023	BYLVAY, LIVMARLI	743 KB
PDF File	Imcivree - HHSC Eff. Date: 11/13/2023	IMCIVREE	781 KB
PDF File	Imiquimod - HHSC Eff. Date: 10/19/2022	ALDARA, IMIQUIMOD, ZYCLARA	736 KB
PDF File	Increlex - HHSC Eff. Date: 10/19/2022	INCRELEX	969 KB
PDF File	Inhaled Antibiotics HHSC Eff. Date: 10/28/2022	BETHKIS, CAYSTON, KITABIS PAK , TOBI, TOBRAMYCIN	632 KB
PDF File	Ketorolac (Toradol) - HHSC Eff. Date: 09/13/2023	KETOROLAC	1 MB
PDF File	Keveyis - HHSC Eff. Date: 10/28/2022	KEVEYIS	777 KB
PDF File	Lidocaine Patch - HHSC Eff. Date: 01/17/2023	LIDOCAINE, LIDODERM, ZTLIDO	750 KB
PDF File	Lupus Agents - HHSC Eff. Date: 10/22/2021	BENLYSTA, LUPKYNIS	993 KB
PDF File	Lyrica Eff. Date: 09/01/2023	LYRICA, LYRICA CR, PREGABALIN, PREGABALIN ER	223 KB
PDF File	Monoclonal Antibody Agents - HHSC Eff. Date: 03/23/2023	ADBRY, DUPIXENT, FASENRA, NUCALA, XOLAIR	2 MB
PDF File	MS Agents - HHSC Eff. Date: 06/01/2023	AMPYRA, AUBAGIO, DALFAMPRIDINE, MAVENCLAD, MAYZENT, PONVORY, TASCENSO ODT, TERIFLUNOMIDE, ZEPOSIA	1 MB
PDF File	Neurontin (Gabapentin) HHSC Eff. Date: 10/28/2022	GABAPENTIN, GRALISE, HORIZANT, NEURONTIN	2 MB
PDF File	Nitazoxanide (Alinia) - HHSC Eff. Date: 05/24/2022	NITAZOXANIDE	678 KB
PDF File	Nuplazid - HHSC Eff. Date: 03/29/2019	NUPLAZID	419 KB
PDF File	Omega-3 Fatty Acids - HHSC Eff. Date: 09/13/2023	ICOSAPENT ETHYL, LOVAZA, VASCEPA	889 KB
PDF File	Ophthalmic Immunomodulators - HHSC Eff. Date: 04/28/2022	EYSUVIS, RESTASIS MULTIDOSE, RESTASIS EYE EMULSION, TYRVAYA, XIIDRA	601 KB
PDF File	Opioid Policy Criteria - HHSC Eff. Date: 12/15/2022	APAP-CAFF-DIHYDROCOD, APAP-COD, ACTIQ, APADAZ, ASCOMP/COD, BELBUCA, BELLADONNA-OPIUM, BUPRENORPHINE, BUTALB-APAP-CAFF-COD, BUTALB-CAFF-APAP-COD, BUTALBITAL COMP-COD, BUTORPHANOL, BUTRANS, CARISOPRODOL CPD-COD, COD-GUAIFEN, COD SULFATE, DEMEROL, DILAUDID, DOLOPHINE HCL, DSUVIA, DURAGESIC, DVORAH, EMBEDA ER, ENDOCET, FENTANYL, FENTORA, FIORINAL-COD, GUAIFEN-COD , GUAIATUSSIN AC, HYDROCODON-APAP, HYDROCODONE BT-IBU, HYDROCODONE-CHLORPHEN ER, HYDROCOD-HOMATROPINE, HYDROCODONE BT-IBU, HYDROCODONE-IBU , HYDROMET, HYDROMORPHONE, HYDROMORPHONE ER, HYSINGLA ER, KADIAN ER, LAZANDA NASAL SPRAY, LEVORPHANOL, LORCET, MEPERIDINE, METHADONE, METHADOSE, MORPHABOND ER, MORPHINE, MS CONTIN, NALBUPHINE, NALOCET, NINJACOF-XG, NORCO, NUCYNTA, NUCYNTA ER, OPIUM, OXYCODONE, OXYCODONE-APAP, OXYCODONE-ASA , OXYCODONE-IBU, OXYCONTIN, OXYMORPHONE HCL, OXYMORPHONE HCL ER, PENTAZOCINE-NALOXONE, PERCOCET, PROMET-COD, ROXICODONE, SUBSYS SPRAY, TRAMADO, TYLENOL COD, ULTRACET, ULTRAM, VICODIN, VIRTUSSIN, XTAMPZA ER	1 MB
PDF File	Orilissa - HHSC Eff. Date: 3/29/2019	ORILISSA	403 KB
PDF File	Oxervate - HHSC Eff. Date: 12/02/2022	OXERVATE	679 KB
PDF File	Oxycodone Extended Release - HHSC Eff. Date: 03/22/2023	OXYCONTIN, OXYCODONE HCL ER, XTAMPZA ER	2 MB
PDF File	PDE5 - Inhibitors - HHSC Eff. Date: 05/15/2023	ADCIRCA, REVATIO, SILDENAFIL, TADALAFIL, TADLIQ	685 KB
PDF File	Phosphate Binders - HHSC Eff. Date:02/01/2023	AURYXIA, CALCIUM ACETATE, CALPHRON, FOSRENOL, LANTHANUM CARB, PHOSLYRA SOL, RENAGEL, RENVELA, SEVELAMAR, VELPHORO	814 KB
PDF File	Promethazine Agents - HHSC Eff. Date: 10/19/2022	PHENADOZ, PHENERGAN, PROMETHAZINE, PROMETHEGAN	550 KB
PDF File	Propylthiouracil - HHSC Eff. Date: 10/31/2022	PROPYLTHIOURACIL	794 KB
PDF File	Pulmonary Arterial Hypertension Oral/Inhaled Eff. Date: 06/26/2023	ADEMPAS, LETAIRIS, OPSUMIT, ORENITRAM ER, TRACLEER, TYVASO, UPTRAVI, VENTAVIS	226 KB
PDF File	Pulmozyme HHSC Eff. Date: 01/24/2022	PULMOZYME	590 KB
PDF File	Ranexa - HHSC Eff. Date: 10/31/2022	RANEXA	784 KB
PDF File	Recorlev HHSC Eff. Date: 04/22/2022	RECORLEV	849 KB
PDF File	Recurrent Vulvovaginal Candidiasis Agents- HHSC Eff. Date: 10/22/2022	VIVJOA	783 KB
PDF File	Rezurock - HHSC Eff. Date: 10/13/2023	REZUROCK	639 KB
PDF File	Savella - HHSC Eff. Date: 03/29/2019	SAVELLA	669 KB
PDF File	SGLT2 Inhibitor Agents - HHSC Eff. Date: 09/12/2023	FARXIGA, INPEFA, INVOKANA, JARDIANCE, STEGLATRO, INVOKAMET, SEGLUROMET, SYNJARDY, SYNJARDY XR, XIGDUO XR	818 KB
PDF File	Sickle Cell Agents - HHSC Eff. Date: 10/19/2022	OXBRYTA	741 KB
PDF File	Skyclarys - HHSC Eff. Date: 10/13/2023	SKYCLARYS	657 KB
PDF File	Symlin - HHSC Eff. Date: 03/29/2019	SYMLIN, SYMLINPEN	250 KB
PDF File	Synagis - HHSC Eff. 11/01/2023	SYNAGIS 50 MG/0.5 ML VIAL, SYNAGIS 100 MG/1 ML VIAL	857 KB
PDF File	Thiazolidinediones - HHSC Eff. Date: 11/11/2020	ACTOPLUS MET, ACTOPLUS MET XR, PIOGLITAZONE-METFORMIN, ACTOS, DUETACT, PIOGLITAZONE HCL, PIOGLITAZONE-GLIMEPIRIDE, AVANDIA	977 KB
PDF File	Topical Acne Agents Eff. Date: 12/01/2023	AMZEEQ FOAM, BENSAL HP OINTMENT, BENZEFOAM, CLINDAMYCIN FOAM, ERY/BENZOYL GEL, FINACEA FOAM, FINACEA GEL, METRONIDAZOLE LOTION	215 KB
PDF File	Topical Antifungals for Onychomycosis - HHSC Eff. Date: 10/22/2021	CICLOPIROX SOL, JUBLIA SOL, KERYDIN SOL, TAVABOROLE SOL	930 KB
PDF File	Topical Immunomodulators Eff. Date: 09/01/2023	ELIDEL, EUCRISA, OPZELURA, PROTOPIC, TACROLIMUS	733 KB
PDF File	Topical Retinoids Eff. Date: 04/01/2022	ADAPALENE, ADAPALENE-BENZYL PEROX, AKIEF, ALTRENO LOTION, ARAZLO, ATRALIN, AVITA, CLINDA-TRETINOIN, DIFFERIN, EPIDUO, EPIDUO FORTE, FABIOR, TAZAROTENE, TAZORAC, TRETINOIN, TRETINOIN GEL MICRO, ZIANA GEL	414 KB
PDF File	Transthyretin Agents - HHSC Eff. Date: 10/08/2021	TEGSEDI, VYNDAMAX, VYNDAQEL	738 KB
PDF File	Urea Cycle Disorder HHSC Eff. Date: 07/07/2023	BUPHENYL, CARBAGLU, OLPRUVA, RAVICTI, SODIUM PHENYLBUTYRATE	579 KB
PDF File	Veozah - HHSC Eff. Date: 08/14/2023	VEOZAH	797 KB
PDF File	VMAT2 - HHSC Eff. Date: 10/13/2023	AUSTEDO, INGREZZA, TETRABENAZINE, XENAZINE	2 MB
PDF File	Voxzogo HHSC Eff. Date: 04/22/2022	VOXZOGO	625 KB
PDF File	Xifaxan (Rifaximin) - HHSC Eff. Date: 03/29/2019	XIFAXAN	288 KB
PDF File	Xyrem - HHSC Eff. Date: 10/08/2021	XYREM, XYWAV	670 KB
PDF File	Ztalmy - HHSC Eff. Date: 01/20/2023	ZTALMY	667 KB
PDF File	Zyflo Eff. Date: 02/07/2023	ZYFLO	225 KB

Type

Date

Name

File Size

.txt

12/1/2023

Texas-STAR-Kids-Dual-Formulary-12-1-2023

875 kB

.txt

12/1/2023

Texas-STAR-Formulary-12-1-2023

3.3 MB

.txt

12/1/2023

Texas-CHIP-Formulary-12-1-2023

2.5 MB

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